Urine is a metabolic product formed in the kidneys as a result of filtration of the liquid part of the blood, as well as the processes of reabsorption and secretion of various analytes. It consists of 96% water, the remaining 4% comes from nitrogenous products of protein metabolism dissolved in it (urea, uric acid, creatinine, etc.), mineral salts and other substances.
A general urine test in children and adults includes an assessment of the physicochemical characteristics of urine and sediment microscopy. This study allows you to evaluate the function of the kidneys and other internal organs, as well as identify the inflammatory process in the urinary tract
Physicochemical studies of urine include assessment of the following indicators:
- color;
- urine clarity;
- specific gravity (relative density);
- protein concentration;
- glucose concentration;
- bilirubin concentration;
- urobilinogen concentration;
- concentration of ketone bodies;
- nitrite concentration;
- hemoglobin concentration.
Microscopy of urinary sediment includes assessment of the following objects:
Assessment of the physical properties of urine, such as odor, color, turbidity, is carried out using the organoleptic method. The specific gravity of urine is measured using a urometer, a refractometer, or assessed using “dry chemistry” methods (test strips) - visually or on automatic urine analyzers.
Urine color
An adult's urine is yellow. Its shade can vary from light (almost colorless) to amber. The saturation of the yellow color of urine depends on the concentration of substances dissolved in it. With polyuria, urine has a lighter color; with a decrease in diuresis, it acquires a rich yellow tint. The color changes when taking medications (salicylates, etc.) or eating certain foods (beets, blueberries).
Pathologically changed color of urine occurs when:
- hematuria – a type of “meat slop”;
- bilirubinemia (beer color);
- hemoglobinuria or myoglobinuria (black);
- leukocyturia (milky white color).
Urine clarity
Normally, freshly collected urine is completely clear. Turbidity of urine is due to the presence in it of a large number of cellular formations, salts, mucus, bacteria, and fat.
Urine smell
Normally, the smell of urine is not strong. When urine decomposes by bacteria in the air or inside the bladder, for example in the case of cystitis, an ammonia odor appears. Rotted urine that contains protein, blood, or pus, such as from bladder cancer, causes the urine to smell like rotten meat. If there are ketone bodies in the urine, the urine has a fruity odor, reminiscent of the smell of rotting apples.
Urine reaction
The kidneys excrete “unnecessary” substances from the body and retain necessary substances to ensure the exchange of water, electrolytes, glucose, amino acids and maintain acid-base balance. The reaction of urine - pH - largely determines the effectiveness and characteristics of these mechanisms. Normally, the urine reaction is slightly acidic (pH 5.0–7.0). It depends on many factors: age, diet, body temperature, physical activity, kidney condition, etc. The lowest pH values are in the morning on an empty stomach, the highest are after meals. When eating mainly meat foods, the reaction is more acidic, when eating plant foods, the reaction is alkaline. When standing for a long time, urine decomposes, ammonia is released and the pH shifts to the alkaline side.
An alkaline urine reaction is characteristic of chronic urinary tract infection and is also observed with diarrhea and vomiting.
The acidity of urine increases in feverish conditions, diabetes mellitus, tuberculosis of the kidneys or bladder, and renal failure.
Specific gravity (relative density) of urine
Relative density reflects the functional ability of the kidneys to concentrate and dilute urine. Normally functioning kidneys are characterized by wide fluctuations in the specific gravity of urine during the day, which is associated with periodic intake of food, water and fluid loss from the body. The kidneys under various conditions can excrete urine with a relative density of 1.001 to 1.040 g/ml.
There are:
- hyposthenuria (fluctuations in the specific gravity of urine less than 1.010 g/ml);
- isosthenuria (the appearance of a monotonous specific gravity of urine corresponding to that of primary urine (1.010 g/ml);
- hypersthenuria (high specific gravity values).
The maximum upper limit of the specific gravity of urine in healthy people is 1.028 g/ml, in children – 1.025 g/ml. The minimum lower limit for urine specific gravity is 1.003–1.004 g/ml.
To assess the chemical composition of urine, diagnostic test strips (the “dry chemistry” method), produced by different manufacturers, are currently usually used. The chemical methods used in test strips are based on color reactions that produce a change in the color of the test area of the strip at different concentrations of the analyte. Discoloration is determined visually or by reflectance photometry using semi-automated or fully automated urine analyzers, and the results are assessed qualitatively or semi-quantitatively. If a pathological result is detected, the study can be repeated using chemical methods.
Protein
Protein is normally absent in urine or present in concentrations undetectable by conventional methods (traces). Several types of proteinuria (the appearance of protein in the urine) are identified:
- physiological (orthostatic, after increased physical activity, hypothermia);
- glomerular (glomerulonephritis, the action of infectious and allergic factors, hypertension, cardiac decompensation);
- tubular (amyloidosis, acute tubular necrosis, interstitial nephritis, Fanconi syndrome).
- prerenal (myeloma, muscle tissue necrosis, erythrocyte hemolysis);
- postrenal (for cystitis, urethritis, colpitis).
Glucose
Normally, there is no glucose in the urine. The appearance of glucose in the urine can have several reasons:
- physiological (stress, intake of increased amounts of carbohydrates);
- extrarenal (diabetes mellitus, pancreatitis, diffuse liver damage, pancreatic cancer, hyperthyroidism, Itsenko-Cushing's disease, traumatic brain injury, stroke);
- renal (renal diabetes, chronic nephritis, acute renal failure, pregnancy, phosphorus poisoning, certain medications).
Bilirubin
Bilirubin is normally absent in urine. Bilirubinuria is detected in parenchymal liver lesions (hepatitis), obstructive jaundice, cirrhosis, cholestasis, as a result of the action of toxic substances.
Urobilingen
Normal urine contains low concentrations (traces) of urobilinogen. Its level increases sharply with hemolytic jaundice, as well as with toxic and inflammatory lesions of the liver, intestinal diseases (enteritis, constipation).
Ketone bodies
Ketone bodies include acetone, acetoacetic and beta-hydroxybutyric acids. An increase in the excretion of ketones in the urine (ketonuria) occurs when carbohydrate, lipid or protein metabolism is disturbed.
Nitrites
There are no nitrites in normal urine. In urine, they are formed from nitrates of food origin under the influence of bacteria, if the urine was in the bladder for at least 4 hours. The detection of nitrites in properly stored urine samples indicates infection of the urinary tract.
Hemoglobin
Normally absent in urine. Hemoglobinuria - the result of intravascular hemolysis of red blood cells with the release of hemoglobin - is characterized by the release of red or dark brown urine, dysuria, and often lower back pain. With hemoglobinuria, there are no red blood cells in the urine sediment.
Microscopy of urine sediment
Urine sediment is divided into organized (elements of organic origin - red blood cells, leukocytes, epithelial cells, casts, etc.) and unorganized (crystals and amorphous salts).
Research methods
The study is carried out visually in the native preparation using a microscope. In addition to visual microscopic examination, research using automatic and semi-automatic analyzers is used.
Red blood cells
During the day, 2 million red blood cells are excreted in the urine, which, when examining urine sediment, is normally 0–3 red blood cells per field of view for women and 0–1 red blood cell per field of view for men. Hematuria is an increase in red blood cells in the urine above the specified values. There are macrohematuria (the color of urine is changed) and microhematuria (the color of urine is not changed, red blood cells are detected only by microscopy).
In urinary sediment, red blood cells can be unchanged (containing hemoglobin) and changed (deprived of hemoglobin, leached). Fresh, unchanged red blood cells are characteristic of urinary tract lesions (cystitis, urethritis, stone passage).
The appearance of leached red blood cells in the urine is of great diagnostic importance, because they are most often of renal origin and occur in glomerulonephritis, tuberculosis and other kidney diseases. To determine the source of hematuria, a three-glass sample is used. When bleeding from the urethra, hematuria is greatest in the first portion (unchanged red blood cells), from the bladder - in the last portion (unchanged red blood cells). With other sources of bleeding, red blood cells are distributed evenly in all three portions (leached red blood cells).
Leukocytes
Leukocytes are found in small quantities in the urine of a healthy person. The norm for men is 0–3, for women and children 0–6 leukocytes per field of view.
An increase in the number of leukocytes in the urine (leukocyturia, pyuria) in combination with bacteriuria and the presence of clinical symptoms indicates inflammation of an infectious nature in the kidneys or urinary tract.
Epithelial cells
Epithelial cells are almost always found in urinary sediment. Normally, a urine test shows no more than 10 epithelial cells per field of view.
Epithelial cells have different origins:
- squamous epithelial cells enter the urine from the vagina, urethra, their presence has no special diagnostic significance;
- transitional epithelial cells line the mucous membrane of the bladder, ureters, pelvis, and large ducts of the prostate gland. The appearance of a large number of such epithelial cells in the urine can be observed with urolithiasis, neoplasms of the urinary tract and inflammation of the bladder, ureters, pelvis, large ducts of the prostate gland;
- renal epithelial cells are detected in cases of damage to the kidney parenchyma, intoxication, febrile, infectious diseases, and circulatory disorders.
Cylinders
The cylinder is a protein that is coagulated in the lumen of the renal tubules and includes in its matrix any contents of the lumen of the tubules. The cylinders take the shape of the tubules themselves (cylindrical cast). Normally, there are no casts in a urine sample taken for general analysis. The appearance of casts (cylindruria) is a symptom of kidney damage.
Cylinders are distinguished:
- hyaline (with overlay of erythrocytes, leukocytes, renal epithelial cells, amorphous granular masses);
- granular;
- waxy;
- pigmented;
- epithelial;
- erythrocyte;
- leukocyte;
- fatty.
Unorganized sediment
The main component of unorganized urine sediment is salts in the form of crystals or amorphous masses. The nature of the salts depends on the pH of the urine and other properties of the urine. For example, with an acidic reaction of urine, uric acid, urates, oxalates are detected, with an alkaline reaction of urine - calcium, phosphates, ammonium urate. Disorganized sediment does not have any particular diagnostic significance; one can indirectly judge the patient’s propensity for urolithiasis. In a number of pathological conditions, crystals of amino acids, fatty acids, cholesterol, bilirubin, hematoidin, hemosiderin, etc. may appear in the urine.
The appearance of leucine and tyrosine in the urine indicates a severe metabolic disorder, phosphorus poisoning, destructive liver disease, pernicious anemia, leukemia.
Cystine is a congenital disorder of cystine metabolism - cystinosis, liver cirrhosis, viral hepatitis, hepatic coma, Wilson's disease (congenital defect of copper metabolism).
Xanthine – xanthinuria is caused by the absence of xanthine oxidase.
Bacteria
Normally, urine in the bladder is sterile. When urinating, germs from the lower urethra enter it.
The appearance of bacteria and leukocytes in a general urine analysis against the background of symptoms (dysuria or fever) indicates a clinically manifested urinary infection.
The presence of bacteria in the urine (even in combination with leukocytes) in the absence of complaints is regarded as asymptomatic bacteriuria. Asymptomatic bacteriuria increases the risk of urinary tract infection, especially during pregnancy.
Yeast mushrooms
The detection of fungi of the genus Candida indicates candidiasis, which most often occurs as a result of irrational antibiotic therapy, the use of immunosuppressants, and cytostatics.
In the urine sediment, blood schistosome eggs (Schistosoma hematobium), elements of the echinococcal bladder (hooks, scolex, brood capsules, fragments of the bladder shell), migrating larvae of intestinal eels (strongylides), washed off with urine from the perineum of the oncosphere of taeniids, pinworm eggs (Enterobius vermicularis) can be found ) and pathogenic protozoa - Trichomonas (Trichomonas urogenitalis), amoebas (Entamoeba histolitika - vegetative forms).
Conditions for sample collection and storage
For general analysis, morning urine is collected. Urine collection is carried out after thorough toileting of the external genitalia without the use of antiseptics. For the study, freshly collected urine is used, stored until analysis for no more than four hours. Samples are stable at temperatures of 2–8 °C for no more than 2 days. The use of preservatives is undesirable. Before the study, the urine is thoroughly mixed.
Urinalysis (general) evaluates the physical and chemical properties of urine and determines the composition of the sediment. On this page: description of urine analysis, norms, interpretation of results.
Physical parameters:
- urine color,
- transparency,
- relative density,
- Urine pH (urine reaction).
Chemical indicators (presence or absence):
- protein,
- glucose,
- urobilinogen,
- bilirubin,
- ketone bodies,
- nitrites.
Microscopy of sediment may reveal:
- epithelium (flat, transitional, renal),
- leukocytes,
- red blood cells,
- cylinders,
- slime.
In addition, the sediment contains salts, crystals of cholesterol, lecithin, tyrosine, hematodin, hemosiderin, fatty acids, neutral fat; bacteria, trichomonas, sperm, yeast.
Indications for urine analysis (general)
Diseases of the kidneys and urinary tract.
Screening examination when visiting specialists of various profiles.
Preparing for the study
The day before, exclude vegetables that change the color of urine (beets), medications (diuretics, aspirin).
In the morning, you need to toilet the external genitalia and collect the urine in a pre-prepared sterile container. Women are not recommended to collect urine for testing during menstruation. Urine must be delivered to the laboratory of a clinic or medical center in the morning of the same day, since after a few hours the physical properties of urine change and sediment elements are destroyed - the analysis becomes uninformative.
Material for research
Urine (morning portion), at least 10 ml.
Decoding the results
Physical properties:
1. Urine color
Norm: straw yellow.
Changes in the color of urine can be caused by foods, medications, or are a sign of certain diseases.
|
Urine color |
Possible cause of color change |
|
Pale yellow, light |
Diabetes insipidus, taking diuretics, decreased renal concentration function, excess water content in the body |
|
Dark yellow |
Dehydration, swelling, vomiting and diarrhea, burns. Edema in heart failure |
|
Beer color |
Parenchymal jaundice due to viral hepatitis |
|
Orange, yellow-orange |
Furagin, Furomag, B vitamins |
|
Kidney infarction, renal colic |
|
|
“Meat slop” color, red-brown |
Acute glomerulonephritis |
|
Beets, blueberries, aspirin |
|
|
Red-brown |
Phenol poisoning. Taking sulfonamides, metronidazole, bearberry-based medications |
|
Greenish yellow color |
Obstructive jaundice (due to blockage of the bile ducts) due to cancer of the head of the pancreas or the presence of gallstones (calculous cholecystitis) |
|
White milky |
Drops of fat, pus or inorganic phosphorus |
|
Black color |
Melanoma, alkaptonuria (hereditary disease), Marchiafava-Michelli disease (paroxysmal nocturnal hemoglobinuria) |
2. Transparency of urine
Norm: transparent.
Cloudy urine can be caused by mucus and epithelium. When urine is stored at low temperatures, its salts may precipitate and cause turbidity. Long-term storage of research material leads to the growth of bacteria in it and clouding of urine.
3. Specific gravity or relative density
Norm for children over 12 years of age and adults: 1010 - 1022 g/l.
The specific gravity of urine is affected by the amount of fluid released, organic compounds (salts, urea), electrolytes - chlorine, sodium and potassium. The more water excreted from the body, the more “diluted” the urine will be and the lower its relative density or specific gravity.
Decreased (hyposthenuria): less than 1010 g/l.
- It is observed in renal failure, when the concentrating ability of the kidneys is impaired.
- Diabetes insipidus;
- Chronic renal failure;
- Drinking large amounts of water, taking diuretics.
Increased (hypersthenuria): more than 1030 g/l.
The presence of protein or glucose in the urine. Occurs when:
- diabetes mellitus that does not respond well to therapy;
- the appearance of protein in the urine during glomerulonephritis;
- intravenous administration of radiocontrast agents, solutions of dextran or mannitol;
- insufficient fluid intake;
- toxicosis of pregnant women.
4. Urine reaction (urine pH)
Norm: 5.5-7.0, acidic or slightly acidic.
The reaction of urine is influenced by the nature of nutrition and the presence of diseases in the body. If a person prefers meat food, then the urine reaction is acidic. When consuming fruits, vegetables and dairy products, the reaction shifts to the alkaline side. In addition to dietary habits, the following reasons are possible.
Alkaline reaction, pH > 7, pH increase:
- respiratory or metabolic alkalosis,
- renal tubular acidosis (type I and II),
- hyperfunction of the parathyroid gland,
- hyperkalemia,
- prolonged vomiting,
- tumors of the urinary system,
- urinary tract and kidney infections caused by urea-splitting bacteria
- taking adrenaline or nicotinamide (vitamin PP).
Acidic, pH about 4, pH decrease:
- respiratory or metabolic acidosis,
- hypokalemia,
- starvation,
- dehydration of the body,
- prolonged fever,
- diabetes,
- tuberculosis,
- taking vitamin C (ascorbic acid), methionine, corticotropin.
Chemical properties:
1. Protein in urine
Norm: absent.
The appearance of protein in the urine is a signal of trouble in the kidneys. An exception is physiological proteinuria (protein in the urine), which is observed during severe physical activity, strong emotional experience, or hypothermia. The permissible protein content is up to 0.033 g/l; it is not determined by conventional reagents for performing a general urine test.
Promotion: more than 0.033 g/l.
Possible reasons:
- kidney damage due to diabetes mellitus (diabetic nephropathy),
- nephrotic syndrome,
- glomerulonephritis,
- multiple myeloma,
- urinary tract infections: urethritis, cystitis,
- malignant neoplasms of the genitourinary system.
2. Glucose in urine
Norm: absent.
During filtration in the renal tubules, glucose is completely reabsorbed in healthy people. Therefore, it is not detected or occurs in minimal quantities - up to 0.8 mmol/l.
Promotion: presence in the analysis. If glucose appears in the urine, there are two reasons:
2. The renal tubules are damaged, so glucose reabsorption does not occur. Occurs in case of poisoning with strychnine, morphine, phosphorus; tubulointerstitial kidney lesions.
3. Bilirubin in urine
Norm: absent.
Biliribun appears in the urine when its concentration in the liver significantly exceeds normal values. This occurs when the liver parenchyma is damaged (viral hepatitis, cirrhosis of the liver) or when there is mechanical blockage of the bile duct and disruption of the outflow of bile (obstructive jaundice, metastases of tumors of other organs to the liver).
4. Urobilinogen in urine
Norm: absent.
Urobilinogen is formed from bilirubin, which is the result of the destruction of hemoglobin.
Promotion: more than 10 µmol/day.
A) Increased breakdown of hemoglobin (hemolytic anemia, transfusion of incompatible blood, resorption of large hematomas, pernicious anemia).
B) Increased formation of urobilinogen in the intestine (intestinal obstruction, enterocolitis, ileitis.
C) An increase in the level of urobilinogen in the blood in case of liver diseases (chronic hepatitis and cirrhosis of the liver) or toxic damage (alcohol, bacterial toxins).
5. Ketone bodies
Norm: are missing.
Ketone bodies include acetone and two acids - acetoacetic and beta-hydroxybutyric. They are formed during the increased destruction of fatty acids in the body. Their determination is important for monitoring patients with diabetes. If ketone bodies are found in the urine, it means that insulin therapy is not selected correctly. Ketoacidosis is accompanied by increased blood glucose levels, fluid loss, and electrolyte imbalance. It may end in hyperglycemic coma.
Conditions accompanied by the appearance of ketone bodies in the urine:
- decompensated diabetes mellitus,
- hyperglycemic cerebral coma,
- severe fever
- long fasting,
- eclampsia in pregnant women,
- isopropranolol poisoning,
- alcohol intoxication.
6. Nitrites in urine
Norm: are missing.
A healthy person does not have nitrites in their urine. They are formed under the influence of bacteria from nitrates in the bladder if urine is in it for more than 4 hours. If nitrites appear in the urine, this is a sign of a urinary tract infection. More often than others, asymptomatic urinary tract infections are observed in women, in elderly people over 70 years of age, in patients with diabetes mellitus or gout, and with prostate adenoma.
7. Hemoglobin in urine
Norm: absent.
When performing the analysis, it is almost impossible to distinguish between myoglobin and hemoglobin. Therefore, the laboratory technician often describes the appearance of myoglobin in the urine as “hemoglobin in the urine.” Both proteins should not appear in the urine. The presence of hemoglobin indicates:
- severe hemolytic anemia,
- sepsis,
- burns,
- poisoning with poisonous mushrooms, phenol, sulfonamides.
Myoglobin appears when:
Microscopy of sediment in urine analysis
To obtain a precipitate, a 10 ml tube is placed in a centrifuge. As a result, the sediment may include cells, crystals, and cylinders.
1. Red blood cells in urine
Norm: up to 2 in view
Red blood cells- these are blood cells. Normally, up to 2 red blood cells per 1 μl of urine enter the urine. This amount does not change its color. The appearance of a large number of red blood cells (hematuria, blood in the urine) indicates bleeding in any part of the urinary system. In this case, menstruation in women should be excluded.
Promotion: more than 2 in view.
- stones in the kidneys or ureters,
- glomerulonephritis,
- pyelonephritis,
- tumor of the genitourinary system,
- kidney injury,
- hemorrhagic diathesis,
- systemic lupus erythematosus,
- incorrectly selected doses of anticoagulants.
2. Leukocytes in urine
Norm:
- 0-3 in the field of vision for men,
- 0-5 in the field of vision in women.
White blood cells indicate the presence of inflammation in the kidneys or in the underlying sections. With a pronounced inflammatory process, a large number of leukocytes gives the urine a whitish tint (pyuria, pus in the urine). Sometimes leukocytes become the result of improperly collected urine: they penetrate from the vagina or from the mucous membranes of the external urethra due to poor-quality hygienic toilet.
An increase in the number of leukocytes is a sign of an inflammatory process:
- acute and chronic pyelonephritis,
- glomerulonephritis,
- tubulointerstitial nephritis,
- stones in the ureter.
3. Epithelium in urine
Norm:
- squamous epithelium - in women there are single cells in the field of view,
- in men there are single cells in the preparation.
The epithelium in urine can be squamous, transitional, or renal. In healthy people, several squamous epithelial cells are present in the analysis. An increase in their number indicates a urinary tract infection.
Transitional epithelium appears with cystitis and pyelonephritis.
Renal epithelium is a sign of damage to kidney tissue (glomerulonephritis, pyelonephritis, tubular necrosis, poisoning with heavy metal salts, bismuth preparations).
4. Casts in urine
Norm: hyaline cylinders - single, other cylinders absent
The cylinders are formed from protein and various cells; they may contain bilirubin, hemoglobin, and pigments. These components form cylindrical “casts” of the walls of the renal tubules. There are hyaline, granular, waxy, and erythrocyte casts.
Hyaline casts are formed from a special protein produced by renal epithelial cells (Tamm-Horsfall protein). They are also found in healthy people, but the appearance of a large number of hyaline casts in several repeated analyzes indicates:
- glomerulonephritis, acute or chronic,
- pyelonephritis,
- kidney tuberculosis,
- kidney tumor,
- congestive heart failure,
Granular casts are the result of the destruction of epithelial cells of the renal tubules. If they are detected at normal body temperature (no fever), then you should suspect:
- glomerulonephritis,
- pyelonephritis,
- lead poisoning,
- acute viral infection.
Waxy casts are a combination of hyaline and granular casts that unite in wide tubules. Their appearance is a sign of chronic kidney disease.
- Kidney amyloidosis,
- chronic renal failure,
- nephrotic syndrome.
Erythrocyte casts are a combination of hyaline casts with red blood cells (blood cells). Their appearance indicates that the source of bleeding, which results in hematuria, is located in the kidneys.
- Acute glomerulonephritis;
- renal vein thrombosis;
- kidney infarction.
Leukocyte casts are a combination of hyaline casts with leukocytes. Characteristic of lupus nephritis in systemic lupus erythematosus, pyelonephritis.
Epithelial casts are extremely rare and are found in acute diffuse glomerulonephritis and in cases of rejection of a transplanted kidney.
5. Bacteria in urine
Norm: are missing.
Bacteria can be detected in the urine before starting to take antibacterial agents and on the first day after the start of treatment. Their detection indicates the presence of an infectious process - pyelonephritis, cystitis, urethritis. For the study, you should collect a morning urine sample.
6. Yeasts
Norm: are missing.
The appearance of yeast fungi of the genus Candida in the urine is a sign of candidiasis that occurs due to improperly selected antibacterial treatment.
7. Inorganic urine sediment, salts and crystals
Norm: are missing.
Various salts are dissolved in urine, which can precipitate or form crystals when the temperature drops or the pH of the urine changes. If a large amount of salts is found in the urine, the risk of kidney stones increases (risk of urolithiasis).
Uric acid and urates are detected in acidic urine (physical activity, preference for meat in the diet, fever), gout, chronic renal failure, dehydration with vomiting and diarrhea.
Hippuric acid crystals are a sign of diabetes, liver disease or eating blueberries, lingonberries.
Amorphous phosphates appear during an alkaline reaction of urine in healthy people, after vomiting or gastric lavage, and with cystitis.
Oxalates are found in the urine when eating foods containing oxalic acid (sorrel, spinach, rhubarb, asparagus), in diabetes mellitus, and pyelonephritis.
Tyrosine and leucine in the urine are a sign of phosphorus poisoning, severe metabolic disorders or pernicious anemia, leukemia.
Cystine occurs in cystinosis, a congenital disorder of cystine metabolism.
Fatty acids and fat enter the urine due to excessive intake of fish oil from food or degenerative changes in the epithelium of the kidney tubules.
Cholesterol in the urine indicates fatty liver degeneration, echinococcosis, chyluria or cystitis.
Bilirubin appears in the urine due to hepatitis, liver cancer or phosphorus poisoning.
Hematoidin is present in the urine during chronic bleeding in the urinary system, especially if there is stagnation of blood.
8. Mucus in urine
Norm: insignificant amount.
The epithelium of the mucous membranes secretes mucus, which is found in small quantities in a healthy body. A lot of mucus occurs during inflammatory processes in the organs of the urinary system.
Symptom map
Select the symptoms that concern you and answer the questions. Find out how serious your problem is and whether you need to see a doctor.
A general urinalysis (UCA) is a laboratory test that is carried out for diagnostic and preventive purposes. This examination is prescribed for any disease in adults and children, including, since its results and interpretation help to assess the overall functioning of the body. To identify pathology, the doctor must know the normal values, as well as the reasons for deviations from these values.
How to prepare for OAM? What do you need to know to decipher the meanings to be as reliable as possible? Is there a table of normal values for adults? You will find the answer to these and other equally important questions in our article.
Full table of deciphering OAM indicators in adults
During the test, many physical, chemical and microscopic indicators are examined. There are generally accepted norms, which are presented in the table below, deviation from which is considered as the presence of a pathological process in the body of an adult.
It should be noted that some indicators when deciphering the results vary depending on the gender of the adult. What are the standards for OAM substances? A breakdown of the results of a general urine test in adults is presented in the table:
| Property/component of biomaterial | Value Limits | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Color of biological fluid | Varies from straw yellow to yellow | |||||||||||||||||||||||||||||||||||||||||||||||||||
| The smell of biomaterial | Weak, unsharp | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Urine clarity | Transparent, without sediment and inclusions | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Density (gram/liter) | From 1010 to 1024 | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Acid-base reaction (pH) | Sour, from 4 to 8 | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Glucose (mmol/liter) | No more than 1 | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Protein (protein, grams/liter) | No more than 0.033 | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Red blood cells | Women have no more than 3 in their field of vision. |
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| Leukocytes | In men, from 0 to 3 in the field of vision. In women the figure is slightly higher, up to 7 in the field of view. Reasons for deviations in physical and chemical propertiesThere are quite a few reasons why indicators deviate from the table of normal values. To identify the etiology when deciphering the results obtained, you need to pay great attention to chemical and physiological data of general analysis of biomaterial:
ColorThe color of urine is normally straw-yellow, light, its change is associated with the following factors:
In the presence of pathology, the color of this biological fluid in adults may lighten or darken. Colorless or slightly yellow urine appears in the following cases::
Reasons for the appearance of dark yellow urine when deciphering the analysis:
You will be interested in: Dark-colored urine, like strong black tea, appears in the presence of the following pathologies:
Urine acquires a pink tint if an adult has eaten a sufficient amount of fruits and vegetables rich in red pigment. These include beets, black grapes, and blueberries. Black urine is recorded extremely rarely in melanoma, acpatnonuria and other rare pathologies. A bright red tint indicates the presence of blood (red blood cells entirely) in the urine, which occurs when:
Brown-gray, cloudy urine (the color of meat slop) is observed in the following cases:
SmellIn a healthy adult, urine has a faint, indistinct odor. However, if problems arise with the pancreas, its smell changes dramatically:  TransparencyIn a healthy state, fresh urine is clear. If it has been left in the container for a short time, slight clouding may occur. This does not indicate pathology. Significant cloudiness in fresh urine indicates the presence of the following health problems::
Acid-base reactionThe normal acidity range is from 4 to 8. Deviation from the established values for adults indicated in the table above is both a decrease and an increase. Reasons for decreased acidity include:
An increase in acidity is observed when:
DensityThe density of urine should not be less than 1010 and more than 1024. Hypersthenuria (increase in density) occurs in the following cases:
Hyposthenuria (decreased biomaterial density) is observed in the following conditions:
Normal values and reasons for deviations of other indicatorsWhen performing an OAM, a laboratory technician examines its microscopic parameters, that is, the presence of various inclusions is detected (protein, red blood cells, epithelium, leukocytes, sugar, and so on). These indicators must also be within the limits of the table of norms, and deviations from it when interpreting the analysis can be associated with numerous pathologies of internal organs. Table of norms, interpretation of clinical urine analysis and reasons for deviation in adult women and men:
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Urine collection algorithm for general analysis:Quick page navigation
Features of deciphering a general urine test in adults, children and pregnant women
A general urine test is a clinical test necessary to make an accurate diagnosis. In laboratory conditions, the physicochemical parameters of this biological fluid are determined, and the sediment is diagnosed separately.
Disturbances in the functioning of the body are primarily manifested in the composition of urine. By noticing deviations from the norm in time, you can avoid severe forms of disease.
Features of urine collection
Submitting urine for analysis requires virtually no effort on the part of the person. The liquid must be collected immediately after sleep in a washed jar. The genital area must be washed before the procedure to prevent bacteria from entering.
For the most accurate results, you should not drink alcohol or diuretics the day before the urine test. Fresh fruits and vegetables can unduly change the color of the liquid. The medical restriction is that cystoscopy should be performed no later than a week before the test.
Women during their menstrual cycle should not allow menstrual blood to enter their urine.
The laboratory accepts a fixed volume of urine, the approximate norm is 50 ml. The collected test must be delivered to the clinic no later than 2 hours after collection.
- If you can’t get urine out within this period of time, you need to put the jar in the refrigerator. The analysis result can be obtained within the next day.
Interpretation of general urine analysis in adults, norms
Each indicator in the urine test result card either corresponds to the norm or indicates a specific disease. For laboratory diagnostics, not only the composition of the liquid is important, but also the color, consistency, and smell.
Table: general urine test norm and interpretation of results in adults
Below the table, all the analysis indicators and possible diseases indicated by a deviation from the norm (increase/decrease) are described in detail.
| Index | Analysis result |
| Color | light yellow |
| Transparency | transparent |
| Density | 1010 - 1022 g/l |
| pH reaction | sour 4 - 7 |
| Smell | Unsharp |
| PRO (protein) | 0.033 g/l |
| GLU (glucose) | 0.8 mmol/l |
| KET (ketone bodies) | no (negative) |
| BIL (bilirubin) | No |
| URO (urobilinogen) | No |
| Hemoglobin | No |
| LEU (leukocytes) | 0 - 3 (m) \ 0 - 6 (w) |
| BLD (red blood cells) | (m) single \ (f) 2 - 3 |
| Epithelium | to 10 |
| Cylinders | No |
| Salts | No |
| NIT (nitrates and bacteria) | No |
| Fungus | No |
Let's look at each indicator separately.
Urine color
Decoding the urine test begins with assessing the color of the liquid. In adults, the norm is shades from light yellow to rich straw. Other color variations indicate disturbances in the functioning of organs. The deviations are as follows:
- Pale urine indicates excessive fluid intake, pancreatic dysfunction (diabetes mellitus and diabetes insipidus) and renal failure.
- The ocher color is classic dehydration from intoxication or heart failure.
- Brown urine is a liver disease (hepatitis, cirrhosis), destruction of red blood cells after certain infections, especially after malaria.
- A bright red tint indicates the presence of blood in the urine. May be caused by the presence of stones in the bladder, kidney infarction, pyelonephritis (acute course), urinary tract cancer.
- A faded red color indicates abundant consumption of “coloring fruits”: beets, carrots, grapes, black currants. Doesn't pose any danger.
- Red-brown urine is a consequence of taking sulfonamides.
- A grayish tint with a pronounced sediment - kidney stones, tuberculosis or kidney infarction, rapid destruction of red blood cells. The use of streptocide and pyramidon also gives this shade.
- Black color - Michelli's disease (hereditary form of anemia), melanoma.
The color of urine is affected by the food taken the day before it is taken. To find out the exact result, it is not advisable to eat colored fruits or take the above medications.
Transparency level
The urine should not become cloudy within 2 hours after collection. A slight presence of mucus and epithelial cells is acceptable. Loss of transparency is possible if the liquid contains:
- Leukocytes – cystitis, pyelonephritis;
- Red blood cells – prostatitis, urolithiasis, cancer;
- Protein cells – glomerulo- and pyelonephritis;
- Bacteria – bacterial cystitis, pyelonephritis;
- Excessive amount of epithelium – renal failure;
- The loss of chalk sediment is urolithiasis.
The clarity of urine is largely influenced by the health of the kidneys. In addition, cloudiness may appear if hygiene is not observed when taking the analysis. Therefore, if pathological abnormalities are detected, it is recommended to conduct a repeat study with another portion of urine.
Urine smell
The test taken may have a subtle odor. The appearance of a specific aroma indicates inflammatory and putrefactive processes in the urinary tract:
- The presence of acetone notes in the smell indicates diabetes;
- The similarity of the smell to feces indicates the presence of a fistula from the rectum;
- Ammonia is felt in the urine due to fermentation processes caused by cystitis;
- The rotten smell is caused by gangrene of the urinary tract.
Urine has a very unpleasant aroma if garlic or horseradish has been ingested.
Specific Gravity (S.G.)
The normal relative density of urine in an adult is from 1.005 to 1.028. The increased specific gravity is caused by a lack of fluid intake or its excessive waste by the body (vomiting, diarrhea, fever, excessive physical activity with increased sweating).
This process can be caused by diabetes mellitus and toxicosis during pregnancy. Decreased urine output is called oliguria.
A reading below normal is caused by kidney failure. Also, a high ratio can be justified by consuming a large volume of fluid or taking diuretics. A more accurate picture of the specific gravity will be shown by taking the analysis within 24 hours - 8 portions are collected every 3 hours.
Urine pH (acidity level)
Acidity in the body changes throughout the day, which is why the test is taken on an empty stomach. During filtration, the kidneys remove hydrogen ions from the blood. The normal pH value of urine is 4-7.
If the PH value is above 7:
- Increased amount of potassium and parathyroid hormones in the blood;
- Lack of animal food;
- Metabolic, respiratory alkalosis;
- Urinary tract infection.
The acidity level increases when taking medications based on adrenaline and nicotinamide.
If the PH value is below 4:
- Decreased amount of potassium in the blood;
- Dehydration, fasting, fever;
- Diabetes;
- Abundant consumption of meat products.
The acidity level decreases when taking diacarb, aspirin, and methionine.
Protein in urine (PRO)
Normally, there should be no protein in the urine (PRO neg). Decoding neg – the absence of any component in the general analysis result card. Traces of protein are found after intense physical exertion or hypothermia.
- A stable positive PRO factor indicates chronic pyelonephritis and hypertension.
Glucose in general urine analysis (GLU)
The presence of sugar in the urine indicates problems with the pancreas. The patient is usually diagnosed with acute pancreatitis, diabetes mellitus, or excessive presence of carbohydrates in the diet.
Ketone bodies (KET)
This indicator is disrupted in people who change their diet to lose weight. The positive effect of the diet is noticeable if ketones are present in the urine. This is due to the fact that the body synthesizes its own fat reserves.
- Medical causes: diabetes mellitus, acute pancreatitis, glycogen storage disease.
Bilirubin (BIL)
There is no bilirubin in a healthy adult body. Its presence indicates liver disease:
- Cirrhosis;
- Viral hepatitis;
- Cholestasis;
- Subhepatic jaundice.
Alcohol and other toxic substances consumed the day before have a similar effect on the analysis results. In chronic alcoholism, pathological changes are persistent.
Urobilinogen (URO)
The presence of urobilinogen indicates that bile enters the small intestine in excess. Characteristic diseases are constipation, jaundice and initial liver damage.
Hemoglobin in urine analysis
Normally, this indicator should be negative. If hemoglobin, which appears during the breakdown of red blood cells, enters the urine, then the patient has one of the following pathologies:
- Extensive heart attack;
- Malaria;
- Crash syndrome (muscle damage due to injury);
- Poisoning by sulfides or mushrooms;
- Bleeding in the urinary system.
Hemoglobin is present in small amounts in the urine normally after a blood transfusion.
Red blood cells (BLD)
The BLD transcript must have no more than 3 units of red blood cells in women and no more than 1 in men. If an accumulation of red blood cells is found in the urine, then there are serious problems with the kidneys:
- Glomerulonephritis;
- Nephrotic syndrome, kidney infarction;
- Urolithiasis disease.
Leukocytes (LEU)
LEU decoding allows up to 6 leukocytes in the urine in women and up to 3 in men. It is this indicator that is considered an indicator of the presence of diseases of the urinary system and kidneys. The diagnosis of leukocyturia can be absolutely anything; an ultrasound of the kidneys and bladder is necessary.
Epithelial cells
Epithelial cells should normally be present in the analysis in small quantities - up to 10. A larger number indicates the presence of an inflammatory process. In laboratory conditions, you can find out the epithelium of which organ is present. This will help in making a diagnosis.
Features of a general urine test in pregnant women
Expectant mothers need to regularly undergo a general urine test. Decoding for pregnant women corresponds to the classical norms of an adult.
Inflammatory processes of the bladder are typical for every second woman carrying a fetus, which is why early diagnosis is important. Kidney pathology is more serious, therefore, examination in a hospital is necessary.
- It is especially important to promptly identify asymptomatic bacteriuria. In this condition, there are no clinical manifestations, but there are changes in the urine - bacteria are detected.
All this can lead to various obstetric complications, so timely use of approved antibiotics is required.
Features of deciphering a general urine test in children
Decoding a general urine test in a child corresponds to the principles of adult diagnosis. Features – more flexible indicators for children under 5 years of age. In the urine of a child, unlike an adult, the following are allowed:
- Protein;
- Glucose;
- Urobilinogen;
- Ketones;
- Bilirubin;
- Salt.
Such components are explained by the early age of children and the characteristics of their diet. Cellular inclusions (leukocytes, erythrocytes) must strictly comply with “adult” standards. The card with the results of a general urine test must be shown to the pediatrician without fail.
Indications for prescribing a urine test
A general urine test is needed to determine almost any disease. It is especially important when it comes to nephritis, nephrosis, nephrosclerosis, pyelonephritis, urolithiasis and other pathologies of the body’s excretory system.
In addition to urinary tract diseases, the analysis helps diagnose tumors and inflammations. This study is called general clinical, because for any patient complaints is included in the standard examination.
A general urine test is indispensable in the following cases:
- Suspicions of an inflammatory process in the renal and urinary canals;
- Transfer of a bacterial infection caused by streptococci (1-2 weeks after recovery);
- The need to find out whether the treatment method is correct and whether there is progress in recovery;
- Additional research as part of any diagnosis;
- Preventive examination of each person 1-2 times a year;
- Detection of bacteriuria (the presence of bacteria in the urine) in the absence of any clinical signs.
When making any diagnosis, a urine test is used in the same way as a blood test. In the result card you can see how the body reacts to the stimulus. The expanded picture helps to clarify simultaneously several aspects in the interaction of internal systems.
You should not forget about preventive analysis 1-2 times a year, because any disease is easier to cure in the early stages.
A general urine test allows one to study in laboratory conditions the physical and physical characteristics of the liquid and microscopic traces of sediment in it, on the basis of which a number of diagnoses that are accompanied by physiological changes in the structure of the substance can be confirmed or refuted.
Using the analysis, it is possible to diagnose kidney diseases, problems with the prostate gland, bladder diseases, tumors, pyelonephritis, as well as a number of pathological conditions in the early stages, when there are no clinical manifestations as such.
How to submit?
To conduct a general urine test, it is necessary to collect morning fluid, which has physiologically accumulated throughout the night. It is this kind of material that is considered to be the most optimal, and the results of its research are considered truthful.
Before collecting the liquid, you need to thoroughly clean the genitourinary organs to prevent foreign pollutants from getting into the liquid. It is necessary to collect urine in sterile containers, preferably sold through a pharmacy chain - so-called containers for biospecimens.
Twelve hours before collecting the substance, you must stop taking any medications that can change the physical and chemical parameters of urine. The analysis itself must be carried out no later than two hours after sample collection.
It is advisable to transport the liquid to the laboratory carefully, at positive temperatures in the range of 5-20 degrees - too low or higher values can affect the sample and distort the true results of the analysis.
Indications for use
A general urine test is prescribed in case of regular mandatory examination, if urinary tract and kidney diseases are suspected. Also, this analysis is prescribed to patients who have suffered a streptococcal infection in the process of a preventive comprehensive study, as well as to assess the effectiveness of treatment and ongoing monitoring of the course of the disease.
Normal indicators. Decoding
In the laboratory, urine is examined for a number of indicators:
Or, for clarity, you can use the following table.